Filtering by Tag: wrists

Upward facing dog- feel free to skip it and take a cobra instead, knees down, less wrist pressure.

So the first two posts in this series covered the woes of full wrist extension in yoga, pilates, athletics, etc. Now that we've established why wrist intensive postures can be too much for musicians (full wrist extension coupled with large load coupled with frequency= ouch!) let's look at some solutions for going to group fitness classes, whether they be yoga, barre, HIIT, or something else.

1. If you regularly go to a vinyasa flow-style class (usually titles might be "vinyasa flow," "Hot flow," "Dynamic stretch," "Power flow,"), feel free to skip any of the vinyasa movements that are wrist intensive (i.e. plank to chaturanga to updog, any arm balances, etc.) Just because everyone else in the class is doing something DOESN'T mean you have to do it, or that you have to repeat a sequence as many times as other people. It doesn’t make you a weaker person to take agency about your own body and what works.

Downward facing dog- ask a teacher for some help with your DFD if you feel like you have shoulder, wrist, and elbow pain.

2. Look for teachers who have experience with injuries, specialized conditions, anatomy, etc. The minimum required hours of training for yoga teaching is only 200 hours and many fitness trainers start doing weekend trainings, so look for folks who have additional teaching experience and have a teaching philosophy that shows adaptability. I have taken classes with teachers who are VERY defensive about modifying or allowing people to skip poses, and I've definitely been guilted into doing things I shouldn't because a teacher came over and said I should explore "my edge" or push myself. Give yourself permission to do what's right for you and don't attend classes where you feel unwelcome because of your restrictions or modifications. Regardless of your age, size, or ability, teachers don’t have a right to make you feel less than others if you don’t do everything they cue in a class.

3. Ask a teacher, trainer, PT, or coach (that you trust) to look at your setup, especially in Downward facing dog, planks, push ups, and other weight bearing positions. They can either help modify or alter the pose in a way that will challenge you but prevent discomfort or strain. They can also help you create a progression that will build strength and progressively load your wrists over time.

4. Look for styles of yoga that don't put as much emphasis in sequencing on wrist intensive poses. Ashtanga, vinyasa, and power classes tend to be more dynamic, weight-bearing, and wrist intensive. Iyengar, "slow flow," restorative, yin, and basics classes are usually slower and less weight bearing before you speed things up. (Bikram also puts minimal stress on the wrists, but I get headaches in 100 degree rooms. I leave that one with you.) If you’re looking at a gym, HIIT, or other class, some trainers throw in push ups for fun every few minutes, others look at quality of movement and more compound complex movements. Investigate, do some research, and make your choice.

The wrist wedge decreases the degree of wrist extension needed.

5. Prop it up! Yoga props are sometimes a mysterious thing for some students, but they can really help to find new ways of practicing.

a. Foam or cork wedges can help decrease the wrist extension.

This is a block that allows gripping instead of placing the hand flat down on the floor or block.

b. Grippy blocks can change the wrist position, but sometimes the gripping can make existing wrist problems worse.

c. Wrist guards- I had a pair of Wags (wrist assured gloves) for many years while I was rehabilitating from my tendonitis (ca. 2009), and they helped amazingly. There are many different sorts of wrist guards out there, but these have a built in wedge of silicone to decrease the angle of wrist extension, which helps a lot. They're also marketed to yoga, pilates, and TRX, so they're not just a yoga thing.

Dolphin (with arms in supinate). A terrific way to strengthen the shoulder without taxing the wrists.

6. Consider trading your downward facing dogs, planks, and side planks for dolphin variations, which is on the forearms. Not only is forearm plank very challenging for the shoulders and core, it's not wrist intensive and will prepare your body for other weight bearing poses.

7. If you don't have any extra props available to you, just fold up the front part of your mat and boom!, you have a built in yoga wedge.

This is a quick fix for any mid-class wrist discomfort (besides taking a break).

8. If a teacher tries to make you feel badly about your limitations, don't take it personally and do what you think is best. Some teachers now have a "more is more" attitude when it comes to vinyasas and intense poses, and they may have no idea about your needs. It's also not a race to see who can do the most chaturangas in a class.

9. Lastly, make sure you have solid hand alignment. Fingers are spread wide, with weight spread throughout the palm and knuckles. There is no one perfect shape for weight bearing hands, but there are definitely less advantageous shapes. When the weight sinks into the base of the palm, and is not distributed throughout the hand, it's often uncomfortable. Some people prefer middle finger pointed forward, others like the hand turned out slightly...different "alignments" for different people. Above all, remember that a lifetime of static positions (holding your instrument) means that your wrists, forearms, and shoulders need to slowly adjust to bearing weight. Whether you're a yoga person, pilates person, or strength and conditioning person, gradual change and adaptation is key.

On Monday, I posted a bit about why your wrists might not easily explore full ranges of extension, especially if you spend your whole musical and technological life in flexion. I additionally had two students in my yoga classes yesterday that complained of wrist pain, and it reminded me that we teachers can do better in teaching progression and strength. First though, what are some of the postures in yoga (and pilates and other movement disciplines) that might create full wrist extension?

This is sometimes seen as "table top," or the beginning of cat cow, or quadruped. It may come at the beginning of class, but it can be hard on the wrists if the range isn't there.

1. Table Top/ Cat- Cow/ Plank

Whether at the top of a pushup or the beginning of a spine warm-up, this set up requires full wrist extension. One way of modifying it is to make a fist and use the knuckles as the contact point with the ground. Another option is to roll up the edge of your mat and decrease the angle of wrist extension needed. Planks on top of physio balls are equally demanding, as well as side planks, so keep in mind that pilates and traditional gym classes may also be taxing.

2. Downward Facing Dog

I mentioned this last time, but DFD requires wrist extension, but not to 90 degrees. It's usually less taxing than the plank to pushup situation, but as with other weight bearing poses, it’s about progression, building strength over time, and not suddenly doing 50 Downward dogs out of the blue.

3. Chaturanga to Upward Facing Dog

This posture, upward facing dog, requires the body weight to be lifted on the wrists, whereas cobra keeps contact between hips and the mat. That's a little tough on the wrists sometimes.

This sequence, often called the vinyasa, requires full range of wrist extension. The easiest thing to do is to skip it when you're tired, or just lower to your belly and do a baby cobra. Upward facing dog itself is super taxing because of the extension, transition through the pushup, and weight combination. This sequence of events is often glossed over in yoga, but it’s a stylized pushup, and pushups are great if your body is prepared, adapted, and ready to be loaded with your body weight, but if not, you may need to work up to the strength required to perform the activity. (Yoga teachers and pilates can also do a better job of training students to get to this point rather than just asking people to do them!)

4. Any arm balance.

This pose is commonly called crow or crane, depending on the variation. For obvious reasons, it can be a bit tough on the paws.

Whether it's crow, side crow, twisted scissors, handstand, or galavasana, your entire body weight is balanced over your hands. If you have weak wrists, limited range of motion, or have no idea if you should be doing arm balances, you probably shouldn't.

5. Full wheel (AKA. Urdhva Dhanurasana)

For years, this was my wrist nemesis. It requires shoulder mobility and wrist mobility, and I always wanted to do it because everyone else could. Even now, I can't hold it for a long time, and I have to be really mindful about warming up my body before I attempt it. Stick with bridge if you're sensitive, or put the hands on blocks against the wall to decrease the range (or grab a hold of the teacher's ankles).

Now that we've looked at some of the wrist extension culprits, we'll address some ways to modify postures to make them more wrist friendly, and how to work on building your range and strength over time.

One of the questions I'm most frequently asked is why yoga makes our wrists hurt so much in yoga, pilates, planks, and other movements. First thing, let's look at the small bones of the wrist and what's going on in there.

Can you tell I'm excited about my new model skeleton?

Our wrist is a somewhat delicate joint, at least in comparison to the foot, which has a very similar structure. The eight carpal bones are very small and fit between the radius/ulna and the metacarpals. (The phalanges are what we think of as the finger bones, but clearly, fingers start from the wrist, not the knuckles!)

We flex the wrist to type and text, we extend the wrist to do plank and down dog.

It also means that we may not have the same range in the opposite direction that some people do.

There are many different styles of yoga, but the many flow styles these days emphasize vinyasas or the sequence of plank, chaturanga, to upward facing dog. Even if those terms don't mean anything to you, think plank to pushup, repeated over and over, which occurs in many fitness formats. So why does this sequence hurt so many folks? Well, most musicians (and normal people) keep their wrists in partial flexion, whether they are desk bound, using their phone, keyboardists, string players, woodwind players, teachers, etc. That partial flexion adds up over the years, especially if we never use the opposite range of motion- wrist extension. The tissues of the palm, hand, and forearm, stay partially contracted, and then limit our range of extension. One day, you decide to try yoga, which demands a lot of wrist extension plus you decide to LOAD your whole body weight on top of it, and then you wonder why things hurt. Staying in one position for a long time (like 15-20 years, many hours a day) keeps the muscles and connective tissue in that position- making it difficult to adapt to the opposite shape of extension.

So there’s two remedies:

1) build the range of motion in extension, and 2) progressively load those tissues to build up strength. If we never use our wrists in extension, we need to gently progress with range of motion and weight, rather than putting 130-230 pounds on our hands out of the blue. That means you can’t go from zero to full plank/push up hour without some gradual change to optimize adaptation.

My wrists are sometimes tight- you can see that it's hard for my thumb to fully rest on the floor without a small bend..

Let's get more specific- planks require full wrist extension (meaning that the distance between the back of the hand and forearm is 90 degrees) whereas down dog is more of a 60 degree angle, depending on many factors.

Notice that the angle between the forearm and wrist is acute, whereas the other is a right angle?

Imagefrom the Melt Method, which has a terrific hand and foot massage kit!

So then, imagine repeating full extension over and over again when you don't actually have that full range, or you only have it on one side. In addition, it’s been days, weeks or months since you’ve done yoga, so your body hasn’t been loaded this way.

First, let's test the range you have in your wrists right now, shall we? Bring your forearms together in front of your chest, then allow your wrists to extend comfortably. Don't force it. Do your wrists naturally open to a 180 degree angle? Or is one side more acute (hello left hand for me!)? That explains why full extension might aggravate things! I'll talk a bit more about poses that are wrist intensive next time, and how to help your wrists out, and possibly gain more range in the long run.

Lately, I've been thinking about how we relay content to students, whether it's as a music instructor or movement instructor. I had an interesting experience in a somatic group class this week, which doesn't necessarily reflect the views of all teachers of this discipline, or even the guild or method. Let me give you the context:

This is a super common and useful human movement. My hips are in flexion, but my spine is in neutral-ish, with a hint of extension.

We were working on the hip hinge, which is a fabulous and important human movement, at the baseline of squatting, dead lifting, etc. I love it, I teach it, it's great, and we were looking at it in the context of picking up objects off the floor. Also great. The other people in the class noticed that the hip hinge felt balanced, used the glutes and back body, and felt stronger, which can all be true. The catch is that at some point, the conversation derailed to how moving at all with a flexed spine is bad, and that's where I disagreed strongly. To be clear, this was not only saying that picking things up off the floor with a flexed spine is bad, but that any flexed spine movements are bad. One of the students asked if a forward fold in yoga was injurious, and the teacher said yes, flexing the spine causes damage and low back pain. This was the first thing that made me angry. The teacher also said that it doesn't honor the curves of the spine. This was the second thing that made me angry. What was the group class takeaway from this? That the body should only be moving in neutral all the time to honor the curves of the spine. Is this possible? Not really. Unless you're superhuman, you sleep with a flexed spine, you walk with subtle rotations and side bends and constant movements in the spine and hips, and if you're reading this, you probably play an instrument, drive a car, and move in all sorts of ways both intentionally and accidentally.

In this image, my spine is rounding over to pick up the object. In previous decades, the thought was that spinal flexion to pick up things led to back pain and disc damage. This opinion has since been debated and refuted.

Is flexing the spine all the time a good idea? Probably not. Is it ok to move the spine in different ways if there isn't a pathology or reason not to? YES. Are all spine movements good for all people? NO. Is it a good idea to hip hinge sometimes? Absolutely. Should I flex my spine to deadlift my grandchild? Probably not, although there is research that weighted spinal flexion is ok for some people and is not always correlated with disc damage and back pain. But I'm in favor of strengthening the back body and inviting glutes and hamstrings to the lifting party.

The other piece of this is load and adaptation- how heavy is the object you're picking up? Is your body adapted to doing the movement? How often are you doing the movement? Do you always pick up objects the same way?

Needless to say, I almost jumped out of my skin in this class, because this may then make students afraid to move their spine in the myriad of ways that are possible at any given time. This is what I think of as fear mongering at it's finest, and it happens in music and movement instruction.

This is especially better because my puppy, Milo, is looking photogenic.

Similarly, in yoga and other movement disciplines, there's often a lot of alignment cues that are absolutely meant to be helpful, but can also lead to the idea that there's one right way to do a pose, movement, or task. Let's take tree pose in yoga, or Vrksasana. I was taught to never put the bent knee sole of foot on the kneecap, and that the sole of foot had to be above or below. What's crazy is that students and teachers in training hear this, and instantly think something HORRIBLE is going to happen the minute someone's sole of foot comes up to their kneecap. Every movement depends on the context: the magnitude, the load, the frequency, the knee! I've seen many a group class where the teacher freaked out because a new student put their opposite sole of foot right on the opposite kneecap. This is perhaps not the best approach. (read Jules Mitchell's blog about the knee: hint, it's not just a hinge joint)

Fear mongering is well intentioned and comes from a place of wanting to help students, but it can lead to long term fears that are not helpful. On one hand, we have the dilemma of The Christmas Story Red Rifle gun, "You'll shoot your eye out," which not only doesn't deter Ralph but makes him think once he has one that he did shoot his eye out. On the other hand, there are students who fear every movement because someone has told them that x,y, and z are wrong with them and they can't do anything. Of course if someone has a pathology or injury, that's different, but if someone does not have an issue, how are we conveying information?

As a student in college, I was told by a music instructor to avoid any weight bearing work on my wrists, arms, and shoulders, and that I'd hurt myself. This made me

1) globally weak in my upper body

2) eventually injured from when I did anything

3) convinced I couldn't do anything because I "had weak wrists"

What's true in this situation? We need to gradually build strength and adaptation to load. Do you love yoga but not how it feels on your wrists? You need to build the range of motion and adaptation for that, rather than going once a week for constant wrist extension and then never doing those same movements during the day or week. As a person who now does lots of shoulder training and wrist extension work, it's about incremental progression. Just as we wouldn't expect to play a concerto at tempo in a week, we can't expect our bodies to do foreign movements suddenly without preparation.

The big takeaway for me is that our words as teachers matter immensely, and that when we set up movements as good or bad, our students will take our viewpoints and authority very seriously, almost too seriously. Part 2 to follow!

So I'm sure I've ranted before that musicians should take anatomy/physiology classes and learn a bit more about self-care, but more importantly, let's look at some of the most frequent myths I get to bust in lessons, classes, friendly conversations, and emails.

A lovely small image from Gray's Anatomy.

1. Your rotator cuff is one giant muscle, and you can tear it. Well, yes, you can, but the rotator cuff actually refers to four muscles that assist in the movement of your arm and scapula. If someone tells me they hurt their shoulder and "tore my rotator," I always ask them which one, which they inevitably can never answer. ( At least figure out what range of motion hurts, and then remember which muscle you hurt. "Everything hurts" is not helpful.)

2. Your core refers to your abdominals exclusively. I despite this misunderstanding, perpetuated by the fitness realm of "burn," "shred," "melt," and "tone," your abs. Your core, refers to the entire muscular sheathing of your viscera and spine, which includes your abdominals (6 pack, obliques, transverse), back muscles, diaphraghm, psoas, and more, depending on your definition. Some folks define core as include hip musculature too, so that's open for debate. Either way, your 6 pack is not your core, although it is part of it, and doing sit-ups will not invariably cure back pain although strengthening the whole core might help.

Image courtesy of radiologyinfo.org

3. Your fingers start at your knuckles. Nope. While this is not intuitive, the bones that make up your metacarpals and phalanges originate at your wrist. Your wrist position while playing your instrument directly affects your ability to use your fingers, and when you think of fingers articulating, they begin their articulation from the wrist. In addition, your have minimal musculature in the hand, but instead the bulk of your musculature in your forearms.

4. Your respiratory diaphraghm cannot be stretched. So your diaphraghm is a muscle, which means that it can be tight, loose, weak, and strong, in various degrees. Your diaphraghm is also a muscle nestled within your rib cage which helps your lungs to inflate and deflate. In addition, the muscles around your ribs can also be tight, loose, weak, and/or strong, which also affects your respiration. There are interesting ways to stretch your diaphraghm (for another day-ooh la la!) as well as open up the muscles on the sides of the ribs, which can help your breathe more easily and more fully (good for most musicians and people at large). PS. The narrator in this video has a hilarious accent.

Amazing and interesting!

5. The tongue is one big muscle. Your tongue, ladies and gentleman, is a structure composed of eight separate muscles, attaching at various bones including the hyoid bone, mandible, and styoid process. Without dwelling on the anatomy too much, take a look at this picture and be amazed!

6. Standing with my feet turned out is natural. Nope. I've had a chat about this before, especially in relation to violin pedagogy, but here are a few thoughts. Just because everyone does something, doesn't mean it's natural. Everyone currently sits 6-8 hours a day, but that's not biologically natural. Just because everyone turns out their feet doesn't mean that's natural either. The more you turn out your feet and legs, the more likely you hyperextend your knees and flatten your pelvic/low back curves. When your feet face parallel (or close), you walk in a manner that is more biomechanically sound for feet, knees, and hips, and can help change your pain patterning.

BONUS! (Just thought of a few more to add as of 5 PM today.)

7. Sitting, standing, and playing with poor posture won't affect my long term body health. Nope. I've talked about this a lot, and I'm sure it gets boring to read about, but the way you move affects your tissues!

8. Wearing High Heels Regularly Won't Affect My Body. This is a biggie. If you only wear them to sit in, then sure, you might be ok. Walking and standing in them regularly will affect your alignment, your back, your knees, and possibly cause you bunions. Save them for super special occasions and don't regularly concertize or audition in them.

9. Many of the great players had ridiculous setups and strange posture. They didn't hurt -why can't I play that way? In regards to string technique, much has changed in the last fifty years. We no longer teach to learn how to play, but we teach folks (hopefully) in a way that not only imparts knowledge of how to play an instrument, but how to play it sustainably for a long time. I can't know if famous musicians of the twentieth century were ever in physical pain from playing. My guess is, yes, they were in pain sometimes, and no, there weren't an abundance of tools at their disposal for improving their setup. My friend Molly Gebrian said this quite eloquently last week: "Great players played well not because of their (idiosyncratic) technique, but in spite of it." That means you don't necessarily want or need the setup of famous 1940's violinists.

10. If I just take an anti-inflammatory drug, all of my wrist/arm/shoulder/back pain will go away. So if you just treat the symptom (pain/discomfort/tingling) and don't address the cause (misalignment, tension, overuse, too much playing, poor sleeping/standing/sitting alignment, etc.) the pain will most likely be chronic. NSAID's can be important sometimes in treating serious inflammation and wounds, but we often medicate without thinking of the obvious thing: our body has an inflammatory response to treat tissue damage for a biological reason.

"Overuse of the muscles causes cells to break down, releasing waste products, which produces pain and inflammation. Cleanup crews in the form of white bloods cells called macrophages carry away the cellular debris. If you take anti-inflammatory drugs at this time, the natural inflammation process is disrupted and instead of being cleansed away in the blood stream, the trash settles into scar tissue." - Dr Emil Pascarelli

Maybe reconsider the next time you reach for the Advil, and instead ask, "why do I hurt?" and "Is there any other way I can treat this right now?"

While the body is a complex and interesting structure, many of our bodily misconceptions have affected how we play and how teach. If one of these concepts resonated with you (pun intended), think of how it can help your students and your own practice!